In our patient, three episodes of GI bleeding
from an intrapancreatic metastasis presented after a long disease-free interval of 6 years. The two endoscopies performed in the context of the two episodes of upper gastrointestinal bleeding described in the case report were considered relatively innocent. The first episode was described as probable simple duodenal vascular injury – duodenal Dieulafoy. The second episode, despite identification of a polypoid eroded structure, the endoscopic appearance (confirmed by histology) suggested a vascular lesion (angiomatous structure). However, endoscopic revision evidenced a sudden and significant change in the lesion characteristics and growth. It was then described as an infiltrating and ulcerated mass. PR-171 research buy CT did not allow a precise etiological characterization of the lesion. Unfortunately, the radial EUS was suboptimal in terms of quality due to technical constraints, limiting the identification of lesions to the most superficial layers of the wall, which was not coincident with the CT images. Surgical decision was based not only on the endoscopic appearance of the lesion and risk of bleeding, but also taking into account the neoplastic background. We opted not to perform EUS-FNA before surgery because negative results do not change the previously established surgical strategy due to low sensitivity of this technique. Roxadustat cost In conclusion, we think that RCC metastasis should be considered
if any patient with a pancreatic tumour gives past history of surgery for RCC. On the other hand post-nephrectomy patients with RCC suffering from gastrointestinal bleeding must have a complete evaluation, especially endoscopic examination, because late recurrent renal cell carcinoma metastasis to the GI tract should be kept in mind, although rare. Awareness of this entity and a high index of suspicion by the physician and pathologist would help in proper diagnosis and treatment. The authors declare that no experiments were performed
on humans or animals for this investigation. The authors declare that they have followed the protocols Adenosine of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study. The authors have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence is in possession of this document. The authors have no conflicts of interest to declare. “
“Type IV paraesophageal hiatal hernia (PEHH) is characterized by a large defect in the diaphragmatic hiatus that allows other organs, besides stomach, such as the colon, pancreas, spleen, or small intestine to herniate into the thorax.1 Herniation of the pancreas through a gastroesophageal hiatus is a rare condition, and only a few cases have been reported in the literature.